Pediatric Evaluation of Ventilation and Respiration Flashcards
What should be evaluated in all patients?
breathing mechanics
Which systems are going to most impact respiration?
- cardiovascular/pulmonary
- musculoskeletal
- neuromuscular
- integumentary
- GI
What always wins?
breathing !!!
Categories to ask about with history
- feeding
- sleeping
- fatigue levels
- overall fitness
- bowel morvmenets
Sxs neonate (0-1mo) is having difficulty breathing
- facial expression, body movements, crying, changes in heart rate, respiratory rate, BP, SaO2, vagal tone, palmar sweating
Sxs Infant (1mo-1yr) is having difficulty breathing
startles, hiccups, gasping, tremors, twitching, yawning, sneezing
Sxs Toddler (1-2yr) is having difficulty breathing
feeding difficulties, irritability, increased crying, grunting, breathing holding, crying that cant be comforted, facial expression (burrowed brow, wrinkled forehead, closed eyes, angry appearance), sleep changes, body movements, clinging to whoever holds them, not moving
Sxs Child is having difficulty breathing
- acting out behaviors, anger problems, stomach aches or headaches, decreased appetite, inability to control emotions, nightmares, clinginess, whining
subjective observations
- postural alignment
- skin
- respiratory system
- what muscles are working/imbalances
Postural alignment
-rib cage position
-rib spacing
-shoulders
-sternum
-spine
-pelvis
By what age is a Childs rib cage most like that of an adult
7-8 years old
**see comparison of infant to adult chest
Normal Chest development of an infant
➢ ⅓ of trunk
➢ triangular
➢ short neck
➢ flared ribs
➢ obligatory belly breather (using
diaphragm)
➢ narrow intercostal
space
Normal chest development - adult
● > ½ trunk cavity
● Rectangular shape
● Wide upper chest
● Lower ribs
integrated with
abdominals
● Wide intercostal
spacing
Children with CP often have:
●Chest high (elevated) (weak abs)
●Chest flattened anteriorly
●Rib flaring
● Small intercostal space
What is a common characteristic of
the rib cage of a child who presents
with hypotonia, such as a child
diagnosed with Down Syndrome?
Rib flaring
reviewing the integumentary system?
- Color
- Scars
- Nail beds
White or bluish tint around mouth
may indicate?
Cyanosis
Is breathing pattern the same for children of all ages?
no
When is abdominal breathing present?
birth
abdominal/thoracic breathing
present at 6-8
months when a child can: sit up against
gravity, actively rotate trunk, actively extend
trunk
When do children progress to adult breathing pattern
8 years old
Adult respiratory pattern
- chest dominant
- diaphragm dominant
- combination/even
- anterior/ lateral/ posterior chest
What/How are muscles working in adult breathing pattern?
- quick/ abrupt initiation
- dominance
- balance
Intercostals
stabilize rib cage during inhalation to prevent chest wall
from being sucked in (paradoxical breathing) by negative pressure
External Intercostals
active during quiet and force inhalation
Internal Intercostals
forced exhalation
diaphragm
contracts and flattens during inhalation then relaxes to push
air out of lungs during exhalation
Abdominals
give dynamic stability
Objectives measures
- Vitals: HR and RR
- FEV-forced expiratory function
- IV-inspiratory function
- Phonation
- Cough
- ROM: shoulder, trunk, hips, pelvis
- Thoracic expansion
- Pectus excavatum measurement
- Endurance
How to take HR
● Take after child has sat quietly for 5 minutes
● Take during last 10 seconds of walking
● Heart rate monitors
● Pulse oximeters
Heart rate has been shown to be…
an accurate
and convenient estimate of energy
expenditure
Child Considerations
●Respiratory rate
●Forced expiratory volume
●Inspiratory volume
●Phonation
●Cough effectiveness
● Thoracic expansion
Premature infant HR and RR
HR: 120-180
RR: 60-80
New born HR and RR
HR: 120-160
RR: 40
Infant HR, BP, RR
HR: 100-140
BP: 80-40
RR: 30-40
Child HR, BP, RR
HR: 80-120
BP: 100/60
RR: 25-30
What is spirometry indicative of?
diagnosing respiratory disease
Testing Phonation
- 8-10 syllable phrase
- “How much is that doggy in the window”
- Timed “ah” or “oh” for 10-12 seconds
Coughing
- Can the child cough?
- What is the quality, strength of cough?
- Do you see three phases: inhalation, thoracic pressure, forced exhalation?
Review assisted coughing
What are developmental considerations when examining thoracic expansion?
- Axilla
- Xiphoid
- Lowest rib (halfway between xiphoid and umbilicus)
Measures of Endurance
● Treadmill
● Bike
● 6 minute walk test
● TUDST
● HR
● EEI
● Functional measures?
energy expenditure index
Method to quantify and compare walking
energy expenditure for children and
adolescents
